Atlanta’s Mental Health Problem — and Ours

H armony lay in a 6-foot-wide stream of her own waste, swaddled in a blanket infused with feces.

Harmony 躺在一条 6 英尺宽的排泄物流中，裹着一条充满粪便的毯子。

She propped up her matted head on her right arm, looking up at two downtown ambassadors from the community improvement district who had come out to ask her to move for the fourth time in a week.

她用右臂支撑着乱七八糟的头，抬头看着市中心社区改善区的两位大使，他们是一周内第四次出来要求她搬家。

They needed to pressure wash the sidewalk.

他们需要高压清洗人行道。

Harmony is not her real name.

和谐不是她的真名。

Atlanta’s powers that be know who she is.

亚特兰大的权力人士都知道她是谁。

Phillip Spillane, a good friend of mine among the ambassadors, had called 911 to get paramedics to take her to Grady Hospital that Friday.

菲利普·斯皮兰（Phillip Spillane）是我在大使中的好朋友，周五他拨打了 911，让护理人员将她送往格雷迪医院。

He has made this call about once every two weeks, when the state of Harmony’s squalor becomes too much to bear for an observer with a soul.

他大约每两周就发出一次这样的电话，当时哈莫尼的肮脏状况对于有灵魂的观察者来说变得难以忍受。

I came upon them as paramedics were piling back into a Grady ambulance.

当护理人员挤进格雷迪救护车时，我遇到了他们。

I watched them drive away, an impassive expression on the face of the paramedic in the passenger seat as she watched Harmony, who remained on the sidewalk.

我看着他们开车离开，副驾驶座上的护理人员看着留在人行道上的哈莫尼，脸上表情冷漠。

It was the same expression on the faces of most of the people walking by.

路过的大多数人脸上都是同样的表情。

I’ve seen it every time I’ve come downtown to Atlanta to talk with her.

每次我到亚特兰大市中心与她交谈时，我都会看到它。

It’s not that passersby don’t notice her, but people make an immediate mental calculation about their ability to help someone in this kind of distress.

路人并不是没有注意到她，而是人们会立即在心里盘算自己有能力帮助陷入这种困境的人。

The social reaction — the human reaction — left over is a carefully deliberate nonchalance meant to provide some dignity to a person in a state of public humiliation and to retain some dignity of their own on the scene of a moral catastrophe.

留下的社会反应——人类的反应——是一种精心蓄意的漠不关心，旨在为处于公开羞辱状态的人提供一些尊严，并在道德灾难的现场保留他们自己的一些尊严。

Of course, some people realize that they’re about to step in her shit and can’t keep from scowling.

当然，有些人意识到他们即将踩到她的狗屎，忍不住皱起了眉头。

Harmony wants to be seen.

和谐希望被看到。

Her survival depends on being seen.

她的生存取决于被人看见。

Dangerous things happen to people out of sight, in her mind.

危险的事情发生在她看不见的人身上，却发生在她的脑海里。

She won’t go into Woodruff Park next to the Walgreens for fear of being attacked.

她不会进入沃尔格林旁边的伍德拉夫公园，因为担心遭到袭击。

But on the sidewalk, people will see her, and some will bring her food as an offering to their own conscience.

但在人行道上，人们会看到她，有些人会给她带来食物，作为对自己良心的祭品。

The lights on Peachtree Street will keep her safe in the darkness, if one can call any of this safe.

桃树街上的灯光将保证她在黑暗中的安全，如果有人能称之为安全的话。

In what universe would someone fighting to keep the black flies from airlifting her off the sidewalk, with all the cops and social workers and the musical dance number of homeless people around her, have the presence of mind to remember my name ?

在哪个宇宙中，有人奋力阻止黑苍蝇将她从人行道上空运出去，周围有所有警察和社会工作者以及音乐舞蹈中的无家可归者，他还能沉着地记住我的名字？

In that flash of casual lucidity, I saw all of her problems illuminated.

在那一瞬间的清醒中，我看到她所有的问题都被阐明了。

If Harmony had the wit to remember me, then, perversely, it meant that she might not be unwell enough to be committed involuntarily to a hospital for treatment.

如果哈莫妮有智慧记住我，那么，反常的是，这意味着她可能不会不适到非自愿地被送往医院接受治疗。

Hearing my own name pissed me off.

听到自己的名字我就生气了。

Harmony isn’t exactly unique; thousands of people in Georgia have mental illnesses and developmental disabilities and addictions, flitting into and out of the state’s care in between long bouts of homelessness.

和谐并不完全是独一无二的。佐治亚州有成千上万的人患有精神疾病、发育障碍和成瘾症，在长期无家可归的情况下不断进出州政府的照顾。

But Harmony is at the center of the Familiar Faces project, an official list of people with severe and persistent illnesses whom Fulton County, where Atlanta is located, and the state desperately want to get off the street and out of the county jail.

但哈莫尼是“熟悉的面孔”项目的中心人物，该项目是一份官方名单，列出了亚特兰大所在的富尔顿县和该州迫切希望摆脱街头和县监狱的患有严重和持续性疾病的人。

I would argue that no one currently experiencing homelessness in Fulton County, if not the state, requires more help than Harmony.

我认为，目前在富尔顿县（即使不是该州）无家可归的人也没有比 Harmony 更需要帮助。

And yet despite millions in resources, much of which the state cannot figure out how to spend, Harmony remained unhoused at the foot of the iconic Coca-Cola sign above the Walgreens at Five Points — in the heart of Atlanta — as she has on and off for years, in a state of abject human degradation, with all of this misery taking place less than 100 yards from the very steps of Georgia’s Department of Behavioral Health and Developmental Disabilities headquarters.

然而，尽管有数以百万计的资源，其中大部分国家无法弄清楚如何使用，哈莫尼仍然无人居住在亚特兰大市中心五点沃尔格林店上方标志性的可口可乐标志脚下，多年来她一直断断续续地处于一种令人悲惨的人类退化状态，所有这些痛苦都发生在距离佐治亚州行为健康和发育障碍部总部的台阶不到100码的地方。

The people who can help her can see her from their offices.

可以帮助她的人可以从办公室看到她。

They might walk by her on the way to lunch.

他们可能会在去吃午饭的路上经过她。

We spend less to treat mental illness than we should.

我们在治疗精神疾病上花费的钱比我们应该花的钱少。

As a result, Georgia is dead last in the 2021 national rankings for access to mental health care, as measured by the nonprofit advocacy group Mental Health America.

结果，根据非营利性倡导组织“美国心理健康”的衡量，佐治亚州在 2021 年获得心理保健服务的全国排名中垫底。

Our miserable placement comes because poor and working-class people cannot afford routine mental health care — Georgia did not expand Medicaid, after all — and because we have about half the mental health providers as the national average.

我们的悲惨处境是因为穷人和工薪阶层无法负担常规的心理健康护理——毕竟佐治亚州没有扩大医疗补助——而且因为我们的心理健康服务提供者数量约为全国平均水平的一半。

Harmony has been the subject of intense discussions with the overseers of a federal consent order with Georgia that requires the state to prevent people with severe and persistent mental illnesses from falling into homelessness after being discharged from state facilities.

和谐一直是与佐治亚州联邦同意令监督者激烈讨论的主题，该令要求该州防止患有严重和持续性精神疾病的人在从州设施出院后陷入无家可归的境地。

But a tug of war between the state, city, county, and others has made it difficult to figure out who should foot the bill for her care.

但州、市、县和其他机构之间的拉锯战使得很难弄清楚谁应该为她的护理买单。

Simple housing seems inadequate — she probably needs residential nursing assistance, since she can’t clean herself, and no one appears to be willing to provide housing without that care.

简单的住房似乎不够——她可能需要住宿护理援助，因为她无法清洁自己，而且如果没有这种护理，似乎没有人愿意提供住房。

The hospitals don’t want her because she doesn’t want to be there.

医院不想要她，因为她不想去那里。

Jail simply exacerbates her mental illness, with no easy alternative for police or social workers to use.

监狱只会加剧她的精神疾病，警察或社会工作者没有其他简单的选择。

And so she is left like an incontinent animal in the backyard, treated primarily as a sanitation problem.

因此，她就像一只失禁的动物一样被留在后院，主要被视为卫生问题。

I didn’t want to focus this story on Harmony.

我不想把这个故事的重点放在和谐上。

I don’t want to exploit the image of her crisis as some act of poverty porn without being able to help her.

我不想在无法帮助她的情况下利用她的危机形象作为某种贫困色情行为。

I have been wrestling with the question of consent, because it is hard to imagine someone living like this who is well enough to participate in the telling of their own story.

我一直在纠结是否同意的问题，因为很难想象像这样生活的人能够健康地参与讲述自己的故事。

I say this, though she has said she wants me to write.

尽管她说她想让我写，但我还是这么说。

Frankly, I didn’t believe her until the day she called me over by name.

坦白说，直到她叫我名字的那一天我才相信她。

It meant that her memory was relatively intact.

这说明她的记忆还算完好。

And that’s the problem.

这就是问题所在。

Because if she’s lucid enough to consent to my reporting, then she’s lucid enough to refuse treatment, which she does regularly.

因为如果她足够清醒地同意我的报告，那么她就足够清醒地拒绝治疗，而她经常这样做。

Harmony’s plight highlights the failures of Georgia’s health care systems — and that makes the story worth telling.

哈莫尼的困境凸显了佐治亚州医疗保健系统的失败——这使得这个故事值得讲述。

The questions I hope to raise are whether we should accept that Harmony’s stated demand to be left alone should be enough, why it takes so long to act, and what our moral and legal choices look like.

我希望提出的问题是，我们是否应该接受 Harmony 提出的不干涉的要求就足够了，为什么需要这么长时间才能采取行动，以及我们的道德和法律选择是什么样的。

H armony is 38 and has been in and out of state hospitals for much of her life, she told me.

H Armony 38 岁，她告诉我，她一生中的大部分时间都在公立医院进出。

She doesn’t like to stay there.

她不喜欢呆在那里。

She will, in fact, fight her way out.

事实上，她会努力争取出路。

Held at a Piedmont Healthcare facility in January, Harmony got mad when a guard asked her to stay in her room, according to court records.

法庭记录显示，一月份，哈莫妮在皮埃蒙特医疗机构被关押，一名警卫要求她呆在自己的房间里，她很生气。

She pushed him, then started smashing computer equipment.

她推了他，然后开始砸电脑设备。

Police charged her with a felony — the first after a long line of misdemeanors — for breaking a laptop.

警方指控她犯有重罪——这是一系列轻罪之后的第一个罪名——破坏笔记本电脑。

She spent 123 days in jail in Newton County before being convicted and sentenced to time served in May, with five years of probation and a required mental health evaluation.

她在牛顿县监狱里度过了 123 天，之后于 5 月被定罪并被判处服刑，缓刑五年并接受必要的心理健康评估。

She told the Newton County court that she was paranoid and schizophrenic, had a ninth-grade education, and was at the time prescribed a suite of psychiatric medications: Seroquel, Depakote, Geodon, Haldol, and Risperdal.

她告诉牛顿县法院，她患有偏执狂和精神分裂症，接受过九年级教育，当时医生给她开了一套精神科药物：思瑞康、德巴克特、Geodon、氟哌啶醇和利培酮。

She also said she was using drugs.

她还说她正在吸毒。

Judge Layla Zon accepted her guilty plea after a few questions to see if Harmony understood what she was agreeing to.

Layla Zon 法官询问了 Harmony 是否理解她同意的内容后接受了她的认罪。

“I am also going to find on the record that the defendant appears to be competent based upon the time that I spent asking her questions,” Zon said.

“根据我询问她问题的时间，我还将在记录中发现被告似乎有能力，”宗说。

“She also appears to be coherent, very responsive appropriately to my questions.

“她看起来也很连贯，对我的问题反应非常恰当。

She is being medicated for the medical diagnosis that she has of paranoid schizophrenia.

她被诊断为偏执型精神分裂症，正在接受药物治疗。

And that medication actually helps her understand the proceedings rather than impair her ability to understand the proceedings.”

这种药物实际上可以帮助她理解整个过程，而不是损害她理解过程的能力。”

After the plea, Harmony spoke up, according to the court transcript.

根据法庭记录，哈莫尼在认罪后发表了讲话。

Harmony told the court she was homeless.

哈莫尼告诉法庭，她无家可归。

The court instructed probation to send her to the Rainbow Community Shelter in Covington because her uncle would no longer take her in.

法院指示缓刑，将她送往卡温顿的彩虹社区收容所，因为她的叔叔不再收留她。

(I have been unable to locate her uncle.) Three days later, the shelter kicked her out for misbehavior, and she found her way back to a downtown Atlanta street corner.

（我一直无法找到她叔叔。）三天后，收容所因行为不当将她赶了出来，她找到了回到亚特兰大市中心街角的路。

People with serious mental health problems in Georgia’s hinterlands almost always find their way to the streets of Atlanta.

佐治亚州内陆地区患有严重心理健康问题的人几乎总是会来到亚特兰大街头。

The most common service delivery strategy in “conservative” counties for homeless people or people who need drug treatment or women running from an abusive spouse is a bus ticket to Peachtree Street.

在“保守”县，为无家可归者、需要戒毒治疗的人或逃离虐待配偶的妇女最常见的服务提供策略是购买前往桃树街的巴士票。

It keeps taxes low and lets them brag about how much “cleaner” their communities are.

它使税收保持在低水平，并让他们吹嘘自己的社区有多么“清洁”。

I spoke with Harmony’s probation officer in Newton County.

我与牛顿县哈莫尼缓刑官进行了交谈。

Harmony never received the post-conviction psychiatric evaluation required by the court.

哈莫尼从未接受过法庭要求的定罪后精神评估。

She has never made a probation meeting.

她从未召开过缓刑会议。

At first the officer was only marginally aware that Harmony was even on her caseload.

起初，这名警官只是勉强意识到哈莫尼也在她的案件中。

Harmony did have an active warrant for her arrest for violating her probation, not that anyone — anyone — really wants her in jail.

哈莫妮确实因违反缓刑而收到了有效的逮捕令，但并不是任何人——任何人——真的希望她入狱。

Because what’s the point?

因为这有什么意义呢？

Unless it’s to force her or someone else to clean her, in ways that are likely to be traumatizing to all involved.

除非是强迫她或其他人清洁她，而这种方式可能会给所有参与者带来创伤。

I stepped in Harmony’s waste as I walked over to her.

当我走向和谐时，我踩到了她的排泄物。

I didn’t realize it at first, of course.

当然，我一开始并没有意识到这一点。

I felt the squish on my shoe as I approached.

当我走近时，我感觉到鞋子被压扁了。

Her shit was everywhere.

她的屎到处都是。

I scraped my sole on the sidewalk without thinking, then realized what had happened.

我不假思索地在人行道上刮伤了脚底，然后意识到发生了什么事。

I tried to ignore it.

我试图忽略它。

Harmony was nude from the waist down, covered with a blanket, as usual.

和往常一样，哈莫尼腰部以下赤裸，盖着毯子。

Her thin top exposed a chest full of open sores.

她单薄的上衣暴露出充满开放性疮口的胸部。

Some had healed and scarred over a bit since the last time we spoke.

自从我们上次谈话以来，有些人已经痊愈并留下了一些疤痕。

Her 300-pound frame was dusted in a light coating of her own feces.

她 300 磅重的身躯上沾满了一层她自己的粪便。

A cloud of black flies buzzed around her.

一群黑苍蝇在她周围嗡嗡作响。

Harmony asked me for food, but I didn’t have time to run to Rosa’s Pizza for her preferred meal of a pepperoni slice.

哈莫妮向我要食物，但我没有时间跑到罗莎披萨店去吃她最喜欢的意大利辣香肠片。

She then asked for pen and paper.

然后她要了笔和纸。

I walked into Walgreens to buy some.

我走进沃尔格林买了一些。

The smell stayed with me.

气味一直伴随着我。

I couldn’t tell if I was imagining it or not.

我不知道这是不是我的想象。

I wondered if I was radiating the smell of her waste as I picked up a notepad and some Sharpies.

当我拿起记事本和一些记号笔时，我想知道我是否散发着她排泄物的气味。

I handed them to her, along with a bag of gummy bears, and she began to fill four pages with one-word lines:

我把它们和一袋小熊软糖一起递给她，她开始在四页纸上写满一行字：

I asked Harmony what they meant.

我问哈莫尼他们的意思是什么。

She sort of shrugged and quietly said that this was her.

她耸耸肩，平静地说，这就是她。

She was describing herself.

她正在描述自己。

Perhaps.

也许。

She was very quiet.

她很安静。

Harmony wanted fresh blankets.

和谐想要新的毯子。

I said I wasn’t in a position to get some for her right then.

我说我当时没办法给她买一些。

She offered me some of her gummy bears.

她给了我一些她的小熊软糖。

I politely refused.

我礼貌地拒绝了。

Harmony saw a white cardboard paper lollipop stick on the sidewalk.

哈莫尼看到人行道上有一根白色纸板棒棒糖。

Wrapped in the soiled blankets, she wasn’t able to reach it.

她裹在脏兮兮的毯子里，够不到它。

She asked me to give it to her, so I picked it up off the shit-smeared sidewalk and handed it over.

她让我把它给她，所以我从沾满粪便的人行道上捡起它并把它交给了她。

She started cleaning out her right ear with it.

她开始用它清理右耳。

And I left.

然后我就离开了。

I went to lunch.

我去吃午饭了。

I sat away from others, wondering if my shoe still smelled of her.

我坐在远离其他人的地方，想知道我的鞋子是否还有她的味道。

I couldn’t go home.

我无法回家。

The entire interaction, punctuated by my own impotence at being able to resolve anything for her, left me vibrating with a kind of moral fury I didn’t want to dump in my own house.

整个互动过程中，我自己无力为她解决任何问题，这让我内心充满了道德上的愤怒，我不想把这种愤怒倾倒在自己的家里。

I went to a movie instead — the theaters remain mostly empty on Friday afternoons.

我去看了电影——周五下午电影院基本上都是空的。

I took a paper towel to my shoe in a sink, found a private spot in a dark corner, and wept where no one could see me.

我在水槽里拿了一张纸巾擦鞋，在黑暗的角落里找了一个私密的地方，在没人看见的地方哭泣。

I had spoken with that crew four days earlier as they were bundling a man I knew well into the back of an ambulance for the third time in a month.

四天前，我与那名工作人员交谈过，当时他们正在一个月内第三次将一名我很熟悉的男子塞进救护车后座。

I stopped to chat.

我停下来聊天。

He’s one of a cast of characters better known downtown by nicknames like Ooo-wee or the Angry Man or Smiley.

他是市中心最著名的人物之一，绰号是“Ooo-wee”、“愤怒的人”或“笑脸”。

I know their real names.

我知道他们的真名。

My friend has a history of passing out drunk on the sidewalk, as he has done for the better part of a decade.

我的朋友有醉倒在人行道上的历史，十年来他一直这样做。

He perked up a bit when he saw me.

当他看到我时，他精神抖擞了一些。

We’ve been speaking for years about his need to stop drinking and get off the street.

多年来我们一直在谈论他需要戒酒并远离街头。

He was sober for a while a couple of years ago.

几年前，他曾一度清醒过。

I wish it had lasted longer.

我希望它能持续更长时间。

A paramedic took out his phone and pulled up a calculator.

一名护理人员拿出手机，拿出一个计算器。

“Every time an ambulance comes to take him to Grady, it costs $1,700,” he said.

“每次救护车来送他去格雷迪，费用为 1,700 美元，”他说。

“That’s before he walks through the door.” They pick him up once a week.

“那是在他走进门之前。”他们每周接他一次。

The state of homelessness and inebriation my friend lives in costs the public about $88,400 a year at minimum, he said.

他说，我朋友的无家可归和醉酒状态每年至少给公众造成约 88,400 美元的损失。

For that much money, four or five people could be provided permanently supportive housing.

用这么多钱，可以为四五个人提供永久的支持性住房。

They knew Harmony well.

他们非常了解Harmony。

When I brought her up, they just shook their heads.

当我提起她时，他们只是摇头。

They come to take her just as often — only she won’t go.

他们也经常来接她——只是她不去。

I asked Harmony that day if she was still OK with me writing a story about her, and she said yes.

那天我问哈莫妮是否还同意我写一篇关于她的故事，她说可以。

If someone offered her an apartment, I asked, would she take it?

我问，如果有人给她一套公寓，她会接受吗？

She said yes to that too.

她也同意了。

I asked her if she would go to a nursing home.

我问她是否愿意去养老院。

She said no.

她说不。

I dreamed that night about what a jail would do with Harmony.

那天晚上我梦见监狱会对哈莫尼做什么。

How would they clean her?

他们要怎么给她清洗呢？

Would they just hose her down like in a prison movie, or would they give her the dignity of cleaning herself?

他们会像监狱电影中那样直接用水管冲洗她，还是会给她清洁自己的尊严？

Could she take a shower?

她可以洗澡吗？

How would they clean the shower?

他们如何清洁淋浴间？

I awoke with a start after dreaming about being trapped in a stopped-up public toilet stall with no toilet paper and people peering through the gaps in the door.

我梦见自己被困在一个堵塞的公共厕所隔间里，没有卫生纸，人们从门缝里往外看，我吓了一跳。

T he next morning, paramedics arrived to take Harmony to Grady and then to a state hospital, come hell or high water.

第二天早上，护理人员赶到，将哈莫尼送往格雷迪，然后送往州立医院，无论天高地厚。

Harmony had finally drawn enough attention.

和谐终于引起了足够的关注。

She refused to go willingly, as usual.

她像往常一样拒绝自愿去。

This time, they shot her full of the aggression-reducing antipsychotic Haldol and carted her away anyway.

这一次，他们给她注射了大量的减少攻击性的抗精神病药物氟哌啶醇，然后还是把她带走了。

It’s about all the things that have to be broken to leave someone in Harmony’s state, living in her own shit on an iconic Atlanta street corner for five months.

这是关于要让一个人留在哈莫尼州、在亚特兰大标志性街角的自己的屎里生活五个月的所有事情。

It’s about how we react to seeing someone like Harmony — the same someone, over and over — or to squalid tent encampments under a highway, or to someone clearly out of their wits begging people in cars at a stoplight.

这是关于我们看到哈莫尼这样的人——同一个人，一遍又一遍——或者高速公路下肮脏的帐篷营地，或者明显失去理智的人在红绿灯处在车里向人们乞讨时的反应。

We ask ourselves what in the cherry-flavored fuck are we doing with our tax money, if this is what we get.

我们问自己，如果这就是我们得到的，我们到底在用我们的税款做什么？

How can we call this a “developed” country when this kind of dismal wretched misery greets us in public places?

当这种令人沮丧的悲惨遭遇出现在公共场所时，我们怎么能称其为“发达国家”呢？

Who do we hold responsible for this failure?

我们该让谁对这次失败负责？

And I’m not talking about reactionary libertarian sociopathy.

我不是在谈论反动的自由意志主义社会病态。

I’m not entertaining amoral bastards who shout “Get a job!” from their SUV window and then call the cops to get rid of “undesirables” in their neighborhood, patting themselves on the back for how their hard work made them successful.

我不会招待那些喊着“找份工作！”的不道德的混蛋。然后打电话给警察，让他们除掉附近的“不受欢迎的人”，为自己的辛勤工作取得成功而沾沾自喜。

Hundreds of thousands of Americans have schizophrenia.

数十万美国人患有精神分裂症。

Schizophrenia cackles at Darwinist meritocracy.

精神分裂症嘲笑达尔文主义的精英统治。

I want people to understand why it takes so damned long for what we laughingly call “the system” to help someone like Harmony.

我希望人们能够理解，为什么我们笑称的“系统”需要这么长时间才能帮助 Harmony 这样的人。

People experiencing chronic homelessness driven by mental illness have often been burned by the system.

因精神疾病而长期无家可归的人常常被这个制度所伤害。

For someone wrestling with delusions, it can take dozens of contacts simply to convince them that a caseworker isn’t a figment of their imagination.

对于那些与妄想作斗争的人来说，可能需要数十次接触才能让他们相信社会工作者并不是他们想象中的虚构人物。

Even when a caseworker gets a client to say yes, they are met with a system that is underfunded, poorly coordinated, riven by competing interests, the last political priority of policymakers, and dependent on private housing providers that manifestly do not give a shit about keeping people off the street.

即使个案工作者让客户同意，他们也会遇到一个资金不足、协调不善、利益冲突、政策制定者最后的政治优先事项、并且依赖私人住房提供商的系统，而这些提供商显然不关心让人们远离街头。

“Mental health is messy,” said Fulton County Commissioner Bob Ellis, in a hearing about establishing a diversion center — something homelessness strategists have been calling for for years.

“心理健康状况很混乱，”富尔顿县专员鲍勃·埃利斯在关于建立转移中心的听证会上说，这是无家可归问题战略家多年来一直呼吁的。

“It involves so many different layers, people want to get into whose role is it.

“它涉及到很多不同的层面，人们想了解它是谁的角色。

That’s part of the reason stuff never gets done.

这就是事情永远无法完成的部分原因。

It’s the state’s role, the county’s role, the city’s role, law enforcement’s role.

这是州的角色、县的角色、市的角色、执法部门的角色。

It’s the family’s role because they need to take care of it.

这是家庭的角色，因为他们需要照顾它。

We can get caught in that trap as well.”

我们也可能陷入这个陷阱。”

H armony is unique.

H Armony 是独一无二的。

And yet there are at least 100 Harmonys on the streets of Atlanta.

然而亚特兰大的街道上至少有 100 家 Harmony。

A few years ago, folks working on strategy around mental illness and jail wanted to better understand who the “highest utilizers” were.

几年前，致力于制定有关精神疾病和监狱策略的人们希望更好地了解谁是“利用率最高的人”。

Who are the people who bounce in and out of jail most frequently?

谁是最常进出监狱的人？

Who is taking a $1,700 ride to Grady once a week?

谁每周花 1,700 美元乘坐一次去格雷迪的车？

From these questions arose a data project to identify and target them for intensive outreach and prioritized service.

从这些问题中产生了一个数据项目，旨在识别他们并针对他们进行密集的外展和优先服务。

Fulton County now calls this the Familiar Faces program.

富尔顿县现在将此称为“熟悉的面孔”计划。

We used to call them frequent flyers.

我们过去称他们为飞行常客。

(I have to wonder if Delta Air Lines objected.) The top hundred make the list.

（我不知道达美航空是否反对。）前一百名进入了名单。

Kristin Schillig, who works for the Fulton County courts, is the keeper of that list.

在富尔顿县法院工作的克里斯汀·席利格（Kristin Schillig）是这份名单的保管人。

Schillig and I have been friends for years.

席利格和我多年来一直是朋友。

We worked together on a judicial task force trying to get people with mental illnesses out of the county’s jail.

我们共同组建了一个司法工作组，试图将患有精神疾病的人带出县监狱。

I peppered her with familiar questions.

我向她提出了一些熟悉的问题。

Familiar Faces cross-references Fulton County Jail data with Grady Hospital’s own high-utilizer tracking system, mental health data, and the Atlanta Jail.

Familiar Faces 将富尔顿县监狱的数据与格雷迪医院自己的高利用率跟踪系统、心理健康数据和亚特兰大监狱进行交叉引用。

The federal government is funding the project now — $250,000 a year, for three years — to see if it can drive down costs and reduce the burden on the jail, she said.

她说，联邦政府现在正在为该项目提供资金——每年 25 万美元，为期三年——看看它是否可以降低成本并减轻监狱的负担。

But she’s learning about where everything goes wrong.

但她正在了解哪里出了问题。

“I think the story for me is that there are so many gaps in the system,” she said, exasperated.

“我认为对我来说故事是系统中存在如此多的差距，”她愤怒地说。

“Georgia is 51st in investment in mental health care.

“乔治亚州在精神卫生保健投资方面排名第 51 位。

We’re working for nothing.

我们的工作毫无意义。

This is, by far, the hardest thing I’ve ever done.

到目前为止，这是我做过的最困难的事情。

The traditional systems, they fall through every crack.”

传统的系统，它们会失败。”

The systems in place to catch high utilizers aren’t working yet.

用于吸引高利用率用户的系统尚未发挥作用。

Of the 100 people identified by Familiar Faces, only two had previous contact with Atlanta’s Policing Alternatives and Diversion Initiative, a pre-arrest diversion program, she said.

她说，在 Familiar Faces 识别的 100 人中，只有两人之前曾接触过亚特兰大警务替代和转移计划（一项逮捕前转移计划）。

“We hear people don’t meet criteria a lot for various community, behavioral health, and housing programs,” she said.

“我们听说人们不太符合各种社区、行为健康和住房计划的标准，”她说。

“Systems in place are so rigid.

“现有的系统非常严格。

There needs to be more flexibility, some flexible funding streams are needed to fill the gaps.

需要更多的灵活性，需要一些灵活的资金来源来填补缺口。

Also, establishing the Center for Diversion and Services is the key missing infrastructure gap to keep Familiar Faces out of jail.

此外，建立转移和服务中心是让熟悉的面孔远离监狱的关键基础设施缺口。

It’s an easy win.”

这是一场轻松的胜利。”

“We have a plan,” she said.

“我们有一个计划，”她说。

“We’ve had other plans.

“我们还有其他计划。

We need action.”

我们需要采取行动。”

Harmony’s arrests are absurd.

哈莫尼的逮捕是荒谬的。

Behold a selection of recent narratives from arrest reports:

请看最近逮捕报告中的一些叙述：

Simple assault: “On the listed date and time Ofc.

简单攻击：“在 Ofc 列出的日期和时间。

Moore and I were enroute to a call when a black female ran up to the patrol car and stating that she needed help and that she wanted to go to jail.

摩尔和我正在去接电话的路上，一名黑人女性跑到巡逻车前，说她需要帮助，并且她想进监狱。

[She] then put her hand in the window and tried to strike Ofc.

[她]然后把手伸进窗户并试图攻击 Ofc。

Moore in the chest with a closed fist, but did not hit him.

摩尔在胸口握紧了拳头，但没有打到他。

When Ofc.

当Ofc.

Moore was taking [her] into custody I went over to assist him and [she] kicked me in the leg stating that she wants to go to jail because she has not slept in a long time.

摩尔正在拘留[她]，我走过去协助他，[她]踢了我的腿，说她想进监狱，因为她已经很长时间没有睡觉了。

Grady EMS unit 260 responded to the location because [she] was very irate and was talking out of her head.”

格雷迪 EMS 260 单位对该地点做出了回应，因为[她]非常愤怒并且胡言乱语。”

Larceny (other): “Victim …

盗窃罪（其他）：“受害人……

stated his two bags were taken with a few items but he confronted [her] because she was wearing some of his clothing items.

说他的两个包里有一些物品被拿走，但他质问[她]，因为她穿着他的一些衣服。

[He] did not see who took his bags.

[他]没有看到谁拿走了他的行李。

He stated he left his two bags outside while he entered the Xpress Store and when he came out those bags were gone.

他说，当他进入 Xpress Store 时，他把两个包留在外面了，当他出来时，那些包已经不见了。

Arrestee …

被捕者…

admitted to going inside of the bag and putting clothing items on because her clothes displayed human feces on them.”

承认进入袋子里面并穿上衣服，因为她的衣服上有人类粪便。”

Public urination/defecation: “Officer Randall …

在公共场所排尿/排便：“兰德尔警官……

was flagged down by citizens in the area of 236 Forsyth St. the Garnett Office Building.

被 236 Forsyth St. 加内特办公大楼附近的市民拦下。

While there, Mr. B.

在那里，B 先生

Jones advised that the accused …

琼斯建议被告……

continues to defecate and urinate on city sidewalks.

继续在城市人行道上大小便。

Officer Randall and Brown have warned and arrested the accused in the past for the same violations.

兰德尔警官和布朗警官过去曾因同样的违规行为警告并逮捕了被告。

Today Officer Randall contacted the pre arrest diversion along with Grady which the accused …

今天，兰德尔警官与格雷迪联系了逮捕前转移，被告……

refused saying take me to jail.

拒绝说带我去监狱。

Officer Randall was left with no other resources because the accused behavior would not change.”

兰德尔警官没有其他资源，因为被指控的行为不会改变。”

For every one of these encounters, there are probably a handful of police interactions in which cops didn’t bother to arrest Harmony.

对于每一次遭遇，可能都有几次警察互动中警察没有费心逮捕哈莫尼。

But they didn’t help her either, because there’s no place to take her except jail.

但他们也没有帮助她，因为除了监狱，没有地方可以带走她。

For pre-arrest diversion to work, there has to be a place to divert someone.

为了使逮捕前转移发挥作用，必须有一个地方可以转移某人。

Fulton County Superior Court Judge Robert McBurney presented the Familiar Faces project to Fulton County commissioners earlier this month, hoping to convert part of the city jail to a diversion center, a place where people in crisis can be taken in lieu of arrest.

富尔顿县高等法院法官罗伯特·麦克伯尼本月早些时候向富尔顿县委员提出了“熟悉的面孔”项目，希望将市监狱的一部分改造成一个分流中心，将陷入危机的人转移到一个地方来代替逮捕。

“When 911 is called and an officer responds to a gas station and there’s a gentleman there acting erratically …

“当拨打 911 后，一名警官前往加油站，发现一名绅士行为异常……

the only option we have right now is to take that person to jail,” McBurney said.

我们现在唯一的选择就是把那个人送进监狱，”麦克伯尼说。

“Now that’s not fair.

“现在这不公平。

There’s [the Policing Alternatives and Diversion Initiative], but it doesn’t work 24/7 unfortunately.

有[警务替代方案和转移倡议]，但不幸的是它并不能 24/7 工作。

…

……

PAD is not a cure-all.”

PAD 并不是包治百病的灵丹妙药。”

Three out of four times when a cop rolls up on a high utilizer with rap sheets that are an inch thick — someone about to be charged with criminal trespass, public drunkenness — that person gets arrested because there’s no other option, he said.

他说，四分之三的情况是，当警察用一英寸厚的犯罪记录逮捕一名高利用率的人时——某人将被指控非法侵入、公共场所酗酒——该人会被逮捕，因为没有其他选择。

“They are superutilizers of our jail,” McBurney said.

“他们是我们监狱的超级利用者，”麦克伯尼说。

“They stay longer, they cost more to take care of, and they come back sooner.

“他们停留的时间更长，照顾的费用更高，而且回来得更快。

They’re built-in recidivists.”

他们是天生的累犯。”

It costs about $30,000 a year to keep someone in a jail cell.

将一个人关进监狱每年要花费大约 30,000 美元。

The example McBurney used from Harris County, Texas’s diversion center showed that the government saved $5.50 for every dollar it spent on its diversion center, simply by keeping people out of jail and the hospital.

麦克伯尼使用的得克萨斯州哈里斯县分流中心的例子表明，政府在分流中心每花 1 美元，只需让人们远离监狱和医院，就能节省 5.5 美元。

People working on this problem in Fulton County have been talking about establishing a diversion center since 2018.

自 2018 年以来，富尔顿县解决这一问题的人们一直在讨论建立一个分流中心。

I know this because I tried to get one set up at a county-owned property in Summerhill and was summarily castrated by neighborhood political blowback.

我之所以知道这一点，是因为我试图在夏山的一处县属财产中设立一个机构，但由于邻近的政治反弹而被立即阉割。

Even now, with a proposal to build an alternative to jail in a jail, county commissioners are wrestling with how to do so without impeding other priorities — like jailing people.

即使现在，随着在监狱中建立替代监狱的提议，县专员们仍在努力思考如何在不妨碍其他优先事项（例如监禁人员）的情况下实现这一目标。

“It really impacts what [the sheriff] is trying to do with bed space,” Commissioner Natalie Hall said to McBurney, challenging the idea at the text-messaged behest of Sheriff Patrick Labat.

“这确实影响了（警长）对床位空间的利用，”警长娜塔莉·霍尔对麦克伯尼说，并在警长帕特里克·拉巴特的短信要求下质疑了这个想法。

Every single elected official speaking about the subject of the diversion center — a central component to the city and county’s pre-arrest diversion strategy — extolled the virtues of diversion.

每一位当选官员在谈到分流中心（该市和县逮捕前分流战略的核心组成部分）主题时都赞扬了分流的优点。

But I have to ask where the hell the City Council and Board of Commissioners have been for the last three years.

但我不得不问，市议会和委员会在过去三年里到底去哪儿了？

None of this is new.

这些都不是什么新鲜事。

It’s just everyone’s last political priority.

这只是每个人最后的政治优先事项。

Elected leaders want to look like they care about homelessness and poverty while ignoring calls for actual action.

民选领导人希望让自己看起来关心无家可归和贫困问题，却忽视了采取实际行动的呼吁。

In this case, the need to relieve overcrowding at the county jail is a more pressing political problem than a woman sleeping in her own waste on an Atlanta street corner.

在这种情况下，缓解县监狱人满为患的需要是一个比在亚特兰大街角睡在自己的排泄物中的妇女更紧迫的政治问题。

“This conversation started way before I got here,” said Commissioner Khadijah Abdur-Rahman.

“这次谈话早在我到达这里之前就开始了，”专员哈迪贾·阿卜杜尔·拉赫曼 (Khadijah Abdur-Rahman) 说。

“At some point, we have to move past the conversation.

“在某些时候，我们必须超越谈话。

…

……

Business owners every day have to watch a person with a behavioral issue remove their clothes or for whatever reason have an accident in front of them or in their shop.”

企业主每天都必须看着有行为问题的人脱掉衣服，或者出于某种原因在他们面前或在他们的商店里发生事故。”

H ere’s what it’s supposed to look like: A person with psychiatric trouble (or a bystander) reaches out to a government authority — the cops, the paramedics, the state — to get help.

它应该是这样的：一个有精神问题的人（或旁观者）向政府当局——警察、护理人员、国家——寻求帮助。

Psych paramedics come.

心理护理人员来了。

If a person in trouble won’t go with them, a social worker comes in to enroll that person remotely in social services and find them some housing.

如果遇到麻烦的人不肯和他们一起去，社会工作者就会远程为该人登记参加社会服务，并为他们找到住房。

It might be temporary, like a hotel room, but the contact leads quickly to permanent housing with a connection to social services.

它可能是临时的，比如酒店房间，但这种联系很快就会导致与社会服务有联系的永久住房。

We talk about housing first because that’s the policy the system has been designed around.

我们首先讨论住房，因为这是该系统设计的政策。

People are not expected to get clean or become compliant with their medications or get a job before being given housing.

在获得住房之前，人们不应该保持干净、遵守药物治疗或找到工作。

The housing comes first to help with all the other problems.

住房首先可以帮助解决所有其他问题。

When people are easy, this works.

当人们轻松时，这就会起作用。

But people aren’t always easy.

但人并不总是那么容易。

People in crisis, frankly, rarely are.

坦率地说，处于危机中的人很少。

“At the highest level, maybe we need to make it less hard for people to access our systems,” said my friend Cathryn Marchman, executive director of Partners for Home, Atlanta’s homelessness nonprofit coordinator.

“在最高层面上，也许我们需要降低人们访问我们系统的难度，”我的朋友凯瑟琳·马奇曼 (Cathryn Marchman) 说，她是亚特兰大无家可归者非营利组织协调员 Partners for Home 的执行董事。

“We have to make sure that the opening into these services can’t be this restrictive.

“我们必须确保这些服务的开放不会受到如此限制。

More accessible, lower barrier for anyone who walks through the door — hospital, housing system, whatever kind of resource.

对于任何走进大门的人来说，都更容易获得、更低的障碍——医院、住房系统、任何类型的资源。

My general beef is that nonprofits and service provision across the system has to stop cherry-picking who we serve.”

我的主要不满是，整个系统的非营利组织和服务提供必须停止挑选我们服务的对象。”

Social workers see the same people over and over again.

社会工作者一遍又一遍地见到同一个人。

It scrapes away empathy.

它消除了同理心。

“It’s so hard with Grady because they are so overwhelmed,” Marchman said.

“格雷迪很难受，因为他们不知所措，”马奇曼说。

“In a case like Harmony that is so extreme, I think systems often lose sight of …” She trailed off.

“在像 Harmony 这样极端的案例中，我认为系统经常会忽视……”她的声音逐渐减弱。

“I think they just get jaded.

“我认为他们只是感到厌倦了。

We see behavior as manipulation, as less worthy for access.

我们将行为视为操纵，不值得访问。

And certainly, far more difficult and challenging.”

当然，这要困难得多，也更具挑战性。”

Atlanta is not California.

亚特兰大不是加利福尼亚。

I spent a couple of weeks in Los Angeles a few months ago and San Francisco last year, and I can safely say that there is no equivalent to Skid Row or the Tenderloin in this state.

几个月前，我在洛杉矶呆了几周，去年在旧金山呆了几周，我可以有把握地说，这个州没有与贫民窟或田德隆区相媲美的地方。

Anyone making that comparison should be ignored.

任何进行这种比较的人都应该被忽略。

That said, at the start of the coronavirus pandemic, Atlanta embarked on a massive, federally funded program to scoop up as many people experiencing homelessness as it could and house them.

也就是说，在冠状病毒大流行之初，亚特兰大启动了一项由联邦政府资助的大规模计划，以尽可能多地收容无家可归的人并为他们提供住房。

While quite successful, observers say the void has been filled with people on the street who are much harder to serve.

虽然相当成功，但观察人士表示，这一空白已被街上的人所填补，而这些人更难为他们提供服务。

The Department of Behavioral Health and Developmental Disabilities issued 765 housing vouchers for people with severe and persistent mental illnesses in fiscal year 2021, said Maxwell Ruppersburg, the department’s director of supportive housing.

行为健康和发育障碍部门支持性住房主任马克斯韦尔·拉珀斯堡 (Maxwell Ruppersburg) 表示，该部门在 2021 财年为患有严重和持续性精神疾病的人发放了 765 份住房券。

Only a few more than 200 people actually got housing, even with money in hand from the voucher, he said.

他说，即使手里有代金券上的钱，实际上只有 200 多人真正获得了住房。

The state had a budget of about $27.3 million for supportive housing in 2020.

该州 2020 年支持性住房的预算约为 2730 万美元。

It spent $11.9 million.

它花费了1190万美元。

This fiscal year, the state cut the supportive housing budget to $20.6 million.

本财年，该州将支持性住房预算削减至 2060 万美元。

The state has spent $12.9 million.

该州已花费 1290 万美元。

It would have spent the other $8 million if it could have found people to take the money.

如果它能找到人拿走这笔钱，它就会花掉另外的 800 万美元。

Supportive housing costs $15,000 per year, give or take.

支持性住房每年花费 15,000 美元，无论给予还是接受。

That’s about 533 people left unserved.

大约有 533 人没有得到服务。

“You hear about waiting lists with other programs,” Ruppersburg said.

“你听说过其他项目的等候名单，”鲁珀斯堡说。

“We don’t typically have a waitlist.

“我们通常没有候补名单。

But we have more of a problem with folks receiving vouchers, and then they can’t secure housing.

但我们遇到的问题更多是人们收到代金券，然后他们无法获得住房。

And so the vouchers expire.

这样优惠券就过期了。

Ultimately, they get extensions, but at some point they do expire.”

最终，它们会得到延期，但在某些时候它们确实会过期。”

The reason, simply enough, is that few landlords want to rent to someone they fear will trash their building.

原因很简单，就是很少有房东愿意把房子租给他们担心会破坏他们的建筑物的人。

Housing has been tightening in the Atlanta metro area for the last decade.

过去十年来，亚特兰大都市区的住房供应一直紧张。

There’s no shortage of renters without severe psychiatric problems willing to pay full price for an apartment.

不乏没有严重精神问题且愿意支付全价购买公寓的租客。

And there’s no mechanism in the law to force a landlord to rent to someone.

法律中没有任何机制可以强迫房东将房屋出租给某人。

The easy cases are covered, more or less, at least until the eviction moratorium lifts.

至少在暂停驱逐令解除之前，简单的案件或多或少都受到了保护。

But the moratorium made landlords far more cautious about whom they will rent to, constraining supply all around.

但暂停令让房东对出租给谁更加谨慎，从而限制了各地的供应。

Georgia’s housing policy rests almost entirely on private accommodation, subject to neighbors waging war on Section 8 at zoning board meetings.

佐治亚州的住房政策几乎完全依赖于私人住房，邻居们在分区委员会会议上对第 8 条发起了战争。

“There is an element of housing discrimination that’s occurring.

“存在住房歧视的因素。

First, we never know about it individually,” Ruppersburg said.

首先，我们永远不会单独了解它，”鲁珀斯堡说。

“But it’s fair to believe that that’s happening at a systemic level.”

“但可以公平地相信，这种情况正在系统层面发生。”

The state has a legal standard for involuntary commitment, requiring someone to present “a substantial risk of imminent harm to self or others as manifested by recent overt acts or recent expressed threats of violence which present a probability of physical injury to self or to other persons” or appear “to be so unable to care for his/her own physical health and safety as to create an imminently life-endangering crisis.” Colloquially, people working with mental illness on the street refer to this as a 1013, for the form used to commit someone.

国家对非自愿承诺有一个法律标准，要求某人表现出“对自己或他人造成迫在眉睫伤害的重大风险，表现为最近的公开行为或最近表达的暴力威胁，这可能对自己或他人造成人身伤害”，或者表现出“无法照顾自己的身体健康和安全，从而造成迫在眉睫的生命危机”。通俗地说，街头患有精神疾病的人将此称为 1013，即用于犯罪的表格。

When a cop rolls up to a person showing signs of psychiatric distress, they can make an arrest.

当警察找到一个有精神困扰迹象的人时，他们可以逮捕他。

They can’t 1013 them.

他们不能1013他们。

Only a doctor, licensed social worker, family or marriage counselor, advanced practice nurse, or physician’s assistant can sign the form.

只有医生、有执照的社会工作者、家庭或婚姻顾问、高级执业护士或医生助理才能签署该表格。

That means a cop has to wait for Grady or the state to send an ambulance.

这意味着警察必须等待格雷迪或州政府派出救护车。

Every time a clinician signs the 1013, they put their professional career on the line to say someone is unwell enough to require crisis stabilization whether that person wants it or not.

每当临床医生签署 1013 时，他们都会冒着职业生涯的风险，表示某人的身体状况不佳，需要稳定危机，无论该人是否愿意。

The state legal standard requires hospitalization to be the “least restrictive level of care available for the individual” in order to gain admittance to a state hospital for crisis stabilization.

州法律标准要求住院治疗是“个人可获得的最严格的护理水平”，才能进入州医院以稳定危机。

A hospital can hold someone against their will for crisis stabilization only for five days at a time.

医院为了稳定危机只能违背某人的意愿将其拘留五天。

After that, either the hospital must obtain a legal order for involuntary treatment or the patient must consent willingly to a longer-term stay; otherwise, the patient walks.

此后，医院必须获得非自愿治疗的法律命令，或者患者必须自愿同意长期住院；否则，患者可以行走。

No one with clinical responsibility for Harmony’s care would speak to me on the record about her case, citing privacy laws.

没有人对哈莫尼的护理负有临床责任，不会援引隐私法与我公开谈论她的案件。

The question of admittance has been a bit moot for the last few months, in Harmony’s case, because Georgia Regional Hospital has substantially slowed down its intake of new patients.

在 Harmony 的案例中，入院问题在过去几个月一直有点悬而未决，因为佐治亚地区医院大幅放慢了新病人的接收速度。

“[The Department of Behavioral Health and Developmental Disabilities], along with our health care peers, has been navigating workforce challenges for several months now,” Ruppersburg said.

“[行为健康和发育障碍部门]与我们的医疗保健同行一起，几个月来一直在应对劳动力挑战，”鲁珀斯堡说。

“Our workforce shortages are exacerbated by the additional demands of quarantine units, when needed as a result of the Delta variant, and the increase in demand for behavioral health crisis services nationwide.”

“由于达美变种而需要隔离单位的额外需求，以及全国范围内行为健康危机服务需求的增加，加剧了我们的劳动力短缺。”

In August 2019, Georgia’s state psychiatric hospital averaged about 15 psychiatric care beds out of service.

2019 年 8 月，佐治亚州州立精神病院平均约有 15 张精神科护理床位无法使用。

This August, it lost an average of 99 beds.

今年8月，它平均减少了99张床位。

A legislative committee has been reviewing Georgia’s civil commitment rules.

立法委员会一直在审查佐治亚州的民事承诺规则。

This spring, the Georgia Behavioral Health Reform and Innovation Commission suggested changes to the state’s legal standards.

今年春天，佐治亚州行为健康改革和创新委员会建议修改该州的法律标准。

“This unreasonably high bar forces families and caregivers to postpone intervention until it appears that tragedy is on the verge of striking, even when it is obvious to all that the individual is in crisis and heading swiftly and inevitably to that point,” the panel wrote .

该小组写道：“这种不合理的高标准迫使家庭和护理人员推迟干预，直到悲剧即将发生，即使所有人都清楚地表明个人正处于危机之中，并且迅速且不可避免地走向这一点。”

“Forcing people to get worse before they can get help defies copious research demonstrating that the longer severe mental illness remains untreated, the lower the person’s prospects for recovery are.

“强迫人们在获得帮助之前病情恶化，这违背了大量研究的结果，这些研究表明，严重的精神疾病得不到治疗的时间越长，患者康复的前景就越低。

Of course, it is rarely possible to intervene at the very moment that disaster is imminent.

当然，在灾难即将来临的时刻进行干预是不可能的。

More typically, the waiting allows disaster to occur, causing needless human suffering and victimization, and often damning the individual to face serious criminal charges.”

更常见的是，等待会导致灾难发生，造成不必要的人类痛苦和受害，并常常使个人面临严重的刑事指控。”

The panel said no legal or constitutional imperative requires “imminence” as a standard.

该小组表示，没有任何法律或宪法要求以“紧迫性”作为标准。

At least 20 states recognize psychiatric deterioration as a good enough reason to hospitalize someone without their consent.

至少有 20 个州承认精神恶化是在未经某人同意的情况下将某人住院的充分理由。

“Under the current law, the potential harms recognized as important enough to warrant intervention are, by definition, those that involve serious physical injury or death,” the panel wrote.

该小组写道：“根据现行法律，被认为足够重要、需要干预的潜在危害，根据定义，是那些涉及严重人身伤害或死亡的危害。”

“Unfortunately, this disqualifies many individuals in mental health crisis who may not be facing obvious external dangers, but who are powerless due to loss of insight (ability to recognize their own illness and need for treatment) to volunteer for care and protect their minds from harm that could be irreparable in the absence of timely medical aid.”

“不幸的是，这使许多处于心理健康危机中的人失去了资格，他们可能没有面临明显的外部危险，但由于失去洞察力（认识到自己的疾病和治疗需要的能力）而无力自愿接受护理并保护自己的思想免受伤害，如果没有及时的医疗援助，这种伤害可能是无法弥补的。”

The state famously warehoused patients for most of the last century in ways that led parents to threaten their children with a trip to Milledgeville if they misbehaved.

众所周知，该州在上个世纪的大部分时间里都将病人关在仓库里，导致父母威胁他们的孩子，如果他们行为不端，就去米利奇维尔。

Today Georgia is under a federal consent order that requires the state to provide housing to people with serious and persistent mental illnesses who meet criteria laid out in the court settlement.

如今，佐治亚州遵守一项联邦同意令，要求该州向符合法院和解协议中规定标准的患有严重和持续性精神疾病的人提供住房。

That settlement order defines much of the state treatment that doesn’t start behind prison bars.

该和解令规定了大部分国家待遇，而这些待遇并不是从监狱里开始的。

(For every person with a serious mental illness in a Georgia state mental hospital, five are in prison.) Only recently has the Department of Behavioral Health and Developmental Disabilities begun to reach beyond the agreement to arrange for some new kinds of social services support.

（佐治亚州精神病院里每患有严重精神疾病的人，就有 5 人入狱。）直到最近，行为健康和发育障碍部门才开始超出协议范围，安排一些新的社会服务支持。

“Some of the systems have been established.

“一些制度已经建立。

For example, they’ve increased the number of [Assertive Community Treatment] teams and intensive case management teams, and they’ve created a housing program for people with severe persistent mental illness,” said Susan Walker Goico, head of Atlanta Legal Aid’s Disability Integration Project.

例如，他们增加了[自信社区治疗]团队和强化案件管理团队的数量，并且为患有严重持续性精神疾病的人制定了住房计划，”亚特兰大法律援助机构残疾人融合项目负责人苏珊·沃克·戈伊科(Susan Walker Goico)说。

Most treatment for mental illness doesn’t require hospitalization.

大多数精神疾病的治疗不需要住院。

There’s a strong legal and medical bias for treating mental health in the least restrictive way possible.

以尽可能不受限制的方式治疗心理健康存在强烈的法律和医学偏见。

At best, that would be in one’s own home on an outpatient basis.

最好的情况是在自己家里进行门诊治疗。

Less restrictive than that might be supportive housing or a group home with a therapist, nestled in a neighborhood.

限制较少的可能是支持性住房或位于社区的带有治疗师的集体之家。

Whenever someone proposes a supportive care facility or a group home, NIMBYs lose their minds and assemble in force to block it.

每当有人提议建立支持性护理设施或集体之家时，邻避者就会失去理智，并聚集起来阻止。

“To me, the problem is that the individuals who could benefit from all of these great services have not been reached,” Goico said.

“对我来说，问题在于那些可以从所有这些优质服务中受益的个人尚未惠及，”戈伊科说。

“There has not been a real concerted effort to identify people who need supportive housing and connect them to housing and community services that they need.

“尚未做出真正的协调一致的努力来确定需要支持性住房的人，并将他们与他们需要的住房和社区服务联系起来。

I’m talking about, you know, people who are coming out of prisons and jails, people who are cycling in and out of the emergency department, people who are coming out of Georgia Regional Hospital, public psych hospital, off campus.

我说的是，你知道，那些从监狱里出来的人，那些骑自行车进出急诊室的人，那些从佐治亚地区医院、公立精神病院、校外出来的人。

So, I mean, there are a lot of problems actually making the connection for these people to the services that were created.”

所以，我的意思是，在将这些人与所创建的服务联系起来时，实际上存在很多问题。”

Here’s the thing: In Harmony’s case, as with most of the extreme cases around Atlanta, there’s no shortage of contact.

事情是这样的：在哈莫尼的案例中，就像亚特兰大周围的大多数极端案例一样，并不缺乏接触。

The problem is that it’s often the wrong contact.

问题是，这种联系往往是错误的。

A constellation of observers and interested parties has orbited Harmony for the last five months.

过去五个月里，一群观察员和感兴趣的各方一直围绕和谐号运行。

Tammy Hughes, the social impact director for Central Atlanta Progress, has been demanding action from the city and county.

亚特兰大中部进步组织的社会影响总监塔米·休斯一直要求市县采取行动。

The Atlanta Police Department employs a team of police officers specializing in homeless intervention who have been responding to calls about Harmony.

亚特兰大警察局雇用了一支专门从事无家可归者干预工作的警官团队，他们一直在响应有关和谐的呼吁。

Fulton County’s behavioral health department has been trying to coordinate services with Grady Health System and state hospitals about Harmony’s case for months.

几个月来，富尔顿县行为健康部门一直在努力与格雷迪卫生系统和州立医院就哈莫尼的病例协调服务。

Harmony has a caseworker.

哈莫尼有一名社会工作者。

Caroline Henderson, a care navigator at the Policing Alternatives and Diversion Initiative, has been regularly visiting Harmony on the street corner for months.

卡罗琳·亨德森 (Caroline Henderson) 是“警务替代和分流倡议”的护理导航员，几个月来，她一直定期拜访街角的哈莫尼。

Moki Macias, the initiative’s executive director, like other service providers, politely declined to comment for this story, citing patient privacy.

该计划的执行董事莫基·马西亚斯（Moki Macias）与其他服务提供商一样，以患者隐私为由，礼貌地拒绝对本文发表评论。

At least that’s how it’s supposed to work.

至少它应该是这样工作的。

Roughly 18 percent of all arrests made in the city of Atlanta are divertible, according to figures from PAD.

根据 PAD 的数据，亚特兰大市逮捕的大约 18% 是可以转移的。

Almost all still end in an arrest, though, because the cops cannot be bothered to engage the program, or there is an objection from the arrestee or a victim, or PAD is tied up with another case.

然而，几乎所有案件仍然以逮捕告终，因为警察懒得参与该计划，或者被捕者或受害者提出反对，或者 PAD 与另一起案件有关。

I helped design PAD while I was working for Central Atlanta Progress, and I’ve counted on its staff more than once to help someone with a tough problem over the years.

我在为 Central Atlanta Progress 工作期间帮助设计了 PAD，多年来我不止一次地依靠其员工来帮助解决棘手问题的人。

I have, in fact, stood in Macias’s offices next to the Greyhound station downtown screaming at hospital administrators over the phone because they wouldn’t admit someone who presented herself to me for help.

事实上，我曾经站在市中心灰狗车站旁边的马西亚斯办公室里，通过电话对医院管理人员大喊大叫，因为他们不会接纳向我寻求帮助的人。

And I have also watched that same person refuse to go with a Grady EMT team after an initial intervention.

我还看到同一个人在初步干预后拒绝加入 Grady 急救团队。

The work requires the patience of an anvil.

这项工作需要铁砧般的耐心。

I can’t do it.

我做不到。

My fear is that PAD can’t do it either.

我担心 PAD 也做不到。

By that, I mean that while Atlanta has consistently increased funding for the initiative over the years, it has also consistently expanded PAD’s scope.

我的意思是，虽然亚特兰大多年来不断增加对该计划的资助，但它也不断扩大 PAD 的范围。

With each expansion, the public officials responsible for mental health and public safety have laid more of the burden of ameliorating deep social and structural problems on Macias and her staff of 32 administrators, care navigators, and harm reduction specialists.

随着每一次扩张，负责心理健康和公共安全的公职人员都将更多的负担转移到了马西亚斯及其由 32 名管理人员、护理导航员和减少伤害专家组成的工作人员身上，以改善深层次的社会和结构性问题。

PAD workers are among the few who go under the bridges and into the woods and behind the gas stations to make actual human connections with people in profound distress.

PAD 工作人员是少数走进桥下、树林里和加油站后面，与深陷困境的人们建立真正的人际关系的人之一。

Most of the time, they are responding to a call from Atlanta 311 or police for assistance with a problem that needs a social worker more than a cop.

大多数时候，他们是在回应亚特兰大 311 或警方的求助电话，以解决需要社会工作者而不是警察的问题。

Between 3,000 and 4,000 people are experiencing homelessness in the city of Atlanta right now.

目前亚特兰大市有 3,000 至 4,000 人无家可归。

About one-third of them have a serious and persistent mental illness.

其中大约三分之一患有严重且持续的精神疾病。

One-third of them have a serious drug problem.

其中三分之一有严重的毒品问题。

Often those two groups overlap.

这两个群体经常重叠。

PAD will go out to about 40 new people on the street in a good month, enrolling a dozen or so into its care.

一个月内，PAD 将向街上大约 40 名新人伸出援手，将大约 12 个人纳入其照顾范围。

The city of Atlanta relies on outreach from a handful of caseworkers at Intown Collaborative Ministries to reach chronically homeless people as well.

亚特兰大市也依靠 Intown Collaborative Ministries 的少数个案工作者进行外展活动来接触长期无家可归的人。

(I have served on that organization’s board since 2016.) The state supplements this outreach with 10 three-person teams through Projects for Assistance in Transition from Homelessness.

（我自 2016 年以来一直在该组织的董事会任职。）该州通过“无家可归者过渡援助项目”，组建了 10 个三人团队来补充这一外展活动。

“PATH has often been seen as the primary homeless outreach resource in Atlanta when other programs and funding exist for outreach to individuals experiencing homelessness, including individuals with severe mental illness,” Ruppersburg said.

Ruppersburg 说：“当存在其他项目和资金来为无家可归者（包括患有严重精神疾病的人）提供服务时，PATH 通常被视为亚特兰大主要的无家可归者外展资源。”

“PATH represents an integral part of a larger puzzle.”

“PATH 代表了一个更大的谜题的一个组成部分。”

PATH teams are also supposed to be in the field, building relationships and connecting people with mental illnesses to housing.

PATH 团队也应该在现场建立关系并将患有精神疾病的人与住房联系起来。

In practice, that has diminished substantially since the beginning of the pandemic.

实际上，自大流行开始以来，这种情况已大幅减少。

PATH contacted about 20 percent fewer people in fiscal year 2021 than the previous year and enrolled about 10 percent fewer people into case management services, according to figures provided by the Department of Behavioral Health and Developmental Disabilities.

根据行为健康和发育障碍部提供的数据，2021 财年 PATH 接触的人数比上一年减少了约 20%，参与病例管理服务的人数减少了约 10%。

Given the 31 percent increase in crisis contacts, those numbers suggest that we’re not imagining things when we look onto the street and find more despair than we used to.

鉴于危机接触人数增加了 31%，这些数字表明，当我们看到街上并发现比以前更多的绝望时，我们并不是在想象。

“Each agency has different staffing patterns which may reduce the ability to provide active field work to encampments,” Ruppersburg said.

鲁珀斯堡说：“每个机构都有不同的人员配置模式，这可能会降低为营地提供积极现场工作的能力。”

“We have PATH agencies/teams where three-quarters of the staff has been out of office due to Covid during some period during the pandemic.

“我们的 PATH 机构/团队中有四分之三的员工在大流行期间的某个时期因新冠疫情而缺席。

PATH teams have always had collaborative relationships with stakeholders and community partners providing homeless outreach.”

PATH 团队始终与利益相关者和社区合作伙伴保持着合作关系，为无家可归者提供外展服务。”

Statewide, about 1,547 people receive psychiatric case management through PATH.

全州范围内，约有 1,547 人通过 PATH 接受精神病病例管理。

Half of the state’s PATH teams serve metro Atlanta.

该州一半的 PATH 团队为亚特兰大都会区提供服务。

That means PATH serves about six times as many people as the pre-arrest diversion program.

这意味着 PATH 服务的人数大约是逮捕前转移计划的六倍。

Consider that PAD is on track to increase its caseload by about 100 clients this year.

考虑到 PAD 今年的案件量有望增加约 100 名客户。

That’s roughly the same number of clients that PATH teams lost in metro Atlanta over the same time.

这与 PATH 团队同期在亚特兰大都会区失去的客户数量大致相同。

Far too many people in positions of authority are pointing to PAD as a sign of their police reform credentials and the salvation of serious community problems, while PAD is scrambling to serve the unrelenting avalanche of need around us amid structures that do not work.

太多身居要职的人将 PAD 视为他们警察改革资历和解决严重社区问题的标志，而 PAD 却在无法发挥作用的结构中忙于满足我们周围不断涌现的需求。

I got a call from a Chicago number Thursday night from a woman squatting at a boarded-up house owned by Morehouse College.

周四晚上，我接到一个芝加哥电话号码，是一位女士打来的，她蹲在莫尔豪斯学院 (Morehouse College) 的一栋用木板封起来的房子里。

She had told me a few days earlier that in the course of survival sex work she had been raped repeatedly at the property.

几天前她告诉我，在性工作的生存过程中，她在家里多次被强奸。

I wrote about it.

我写过相关内容。

Morehouse responded by sending workers to throw the squatters’ food and clothing in the back of a truck and bulldozing the tent encampment across the street.

莫尔豪斯的回应是派工人将占屋者的食物和衣服扔到卡车后面，并用推土机推平街对面的帐篷营地。

All pretensions aside about social justice at the school that Martin Luther King Jr. attended, Morehouse has been acquiring nearby properties for 20 years in a neighborhood that has tumbled into despair and neglect, the better I think for the college to buy up land cheaply.

抛开马丁·路德·金就读的学校对社会正义的所有自负，莫尔豪斯二十年来一直在一个陷入绝望和忽视的社区收购附近的房产，我认为对于学院来说，便宜地购买土地更好。

They are not playing nice here.

他们在这里表现得不太好。

Morehouse hit the squatters after dark, impeding news cameras and complicating any kind of social services relief.

莫尔豪斯在天黑后袭击了占屋者，阻碍了新闻摄影，并使任何形式的社会服务救济变得复杂。

PAD stops taking calls at 7 p.m.

PAD 于晚上 7 点停止接听电话

Atlanta’s largest shelter, the Gateway Center, stops intake midday, as does Atlanta Mission.

亚特兰大最大的庇护所盖特威中心 (Gateway Center) 和亚特兰大使命中心 (Atlanta Mission) 都在中午停止接收。

Only the Salvation Army shelter might take someone without special dispensations from social services managers, and they restrict people to 10 days of care a year without enrollment in a program.

只有救世军庇护所可能会接收没有社会服务经理特殊豁免的人，并且他们限制那些没有参加计划的人每年只能接受 10 天的护理。

I made some phone calls and wrangled an after-hours bed at a women’s shelter.

我打了几个电话，并在妇女庇护所争取了一张下班后的床位。

But in the time it took to drive across town, she had disappeared.

但在开车穿过城镇的时候，她就消失了。

Such is the system that left Harmony on a street corner.

这就是让 Harmony 留在街角的系统。

Harmony’s needs are diverse and unusual.

Harmony 的需求多种多样且不同寻常。

The woman I hoped to help Thursday had common problems.

我周四希望帮助的那位女士有一些共同的问题。

Anyone trying to escape a beating from a drunken spouse might run into the same situation I did Thursday night on a rough block in south Atlanta, with everything that works closed for business.

任何试图逃避醉酒配偶殴打的人都可能会遇到我周四晚上在亚特兰大南部的一个简陋街区遇到的同样情况，所有工作都关门了。

A functional system would not depend on personal connections to find help.

一个正常运作的系统不会依赖个人关系来寻求帮助。

It would have flexibility.

它会有灵活性。

It would be able to adapt.

它能够适应。

Now consider how this system will react when 25,000 more people show up looking for help.

现在考虑当又有 25,000 人前来寻求帮助时，该系统将如何反应。

I fear what happens as the eviction moratoriums end and the piles of furniture left on sidewalks grow.

我担心随着暂停驱逐令的结束以及人行道上留下的家具堆积如山，会发生什么。

Atlanta’s poor have long faced housing insecurity.

亚特兰大的穷人长期以来一直面临住房不安全的问题。

Roughly one out of six households in the city had an eviction filing on their record before the pandemic.

该市大约六分之一的家庭在大流行之前就有过驱逐记录。

In the month after the Supreme Court struck down the federal eviction moratorium in September, landlords in Atlanta’s five-county region filed more than 11,000 evictions, according to the Atlanta Regional Commission.

据亚特兰大地区委员会称，最高法院于 9 月推翻联邦暂停驱逐令后的一个月内，亚特兰大五个县地区的房东提出了超过 11,000 次驱逐。

That’s actually fewer than the same month in 2019, but the pace is accelerating.

这实际上比 2019 年同月要少，但速度正在加快。

According to the Atlanta Journal-Constitution, landlords filed about 100,000 evictions during the pandemic, moratorium be damned.

据《亚特兰大宪法报》报道，在疫情期间，房东提出了大约 10 万次驱逐，该死的暂停令。

Some went through because tenants didn’t really know their rights or because they had violated lease agreements.

有些是因为租户并不真正了解自己的权利，或者因为他们违反了租赁协议。

But courts simply placed many evictions on hold.

但法院只是搁置了许多驱逐行动。

About 62 percent of Georgians believe they may be foreclosed on or evicted in the next two months for being behind on payments, according to a U.S. Census Bureau survey conducted last month.

美国人口普查局上个月进行的一项调查显示，约 62% 的格鲁吉亚人认为，他们可能会因拖欠付款而在未来两个月内被取消赎回权或被驱逐。

It is by far the highest percentage in the United States.

这是迄今为止美国最高的比例。

There aren’t actually enough marshals to process all of the evictions that are coming.

实际上没有足够的执法人员来处理所有即将到来的驱逐。

People will be forced from their homes in fits and spurts.

人们将时断时续地被迫离开家园。

Many residents will look for relief from Georgia’s Department of Community Affairs, which has a $1 billion allocation for emergency rental assistance from the federal government.

许多居民将向佐治亚州社区事务部寻求救济，该部已拨款 10 亿美元用于联邦政府的紧急租金援助。

After eight months with cash in hand, the department had spent about 9 percent of its money .

手头有现金八个月后，该部门已经花掉了大约百分之九的钱。

The federal government is probably going to claw some of the remaining cash back.

联邦政府可能会收回部分剩余现金。

Almost none of the people knocking on the Department of Community Affairs’ door have Harmony’s problems.

敲社区事务部大门的人几乎没有一个遇到哈莫尼的问题。

They’ll have different problems.

他们会遇到不同的问题。

And when those problems don’t neatly fit into existing lanes for help, people will fall through the cracks.

当这些问题无法完全融入现有的求助渠道时，人们就会被忽视。

The sheer scale of need will turn those cracks into chasms.

巨大的需求将使这些裂缝变成鸿沟。

I can’t tell how many new faces will be competing with Atlanta’s familiar faces for help.

我不知道有多少新面孔将与亚特兰大的熟悉面孔竞争寻求帮助。

We need to get better at providing assistance to people in need, fast.

我们需要更好地快速为有需要的人提供援助。